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Having been provided an exciting glimpse into the field of organ transplant, half of the group headed to Slidell Memorial Hospital (SMH) in Slidell, Louisiana, about 35 minutes northeast of New Orleans. SMH is a 229-bed acute care community hospital that has been working to enhance the health of the local community for the past 55 years. We were fortunate to be able to spend the afternoon with Dr. William Jeffrey Long, M.D., FACP, FACC, a cardiologist who graduated from Dartmouth College in 1976.

In March 2015, six medical students in Geisel's Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city's challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Shadowing Dr. Jefferey Long at Slidell Memorial Hospital

By: Brendin Beaulieu-Jones '18

UHS-Nola-6Having been provided an exciting glimpse into the field of organ transplant, half of the group headed to Slidell Memorial Hospital (SMH) in Slidell, Louisiana, about 35 minutes northeast of New Orleans. SMH is a 229-bed acute care community hospital that has been working to enhance the health of the local community for the past 55 years. We were fortunate to be able to spend the afternoon with Dr. William Jeffrey Long, M.D., FACP, FACC, a cardiologist who graduated from Dartmouth College in 1976.

A former U.S. Air Force fighter pilot and physician, Dr. Long has a storied history and was eager to share his experiences and insights with our group. Dr. Long was an interventionalist for many years prior to retiring from the cath lab. Our experience shadowing Dr. Long exposed the different aspects of cardiology, and we were fortunate to have the opportunity to interview and conduct a physical exam on a new patient. It was a fun experience to work collaboratively to apply our On Doc skills to interview the patient and complete a physical exam. Like any good teacher, Dr. Long asked us to present the patient and then challenged us to determine the differential diagnosis.  We also joined Dr. Long on his rounds through the hospital and ICU, which highlighted another component of his work.

In addition, Dr. Long arranged for us to meet with Bill Davis, who serves as SMH’s Chief Executive. Having joined SMH as its CFO in 2001, Davis described how he had helped lead the facility from a precarious financial and operational situation to being a healthcare leader and important resource to the community. It was valuable to hear how Davis responded to an evolving national health care sphere as well as an ever-changing local landscape. In addition, it was valuable to learn how Davis advanced existing health care services and collaborated with community support agencies to prioritize preventative medicine.

The afternoon provided valuable exposure to both cardiology and hospital administration, which opened all of our eyes to new possibilities within health care. We greatly appreciate the time we were able to spend at SMH, and wish we could have accepted Dr. Long’s invitation to search for some alligators on his riverboat in the swamps of Louisiana. Hopefully, the class of 2019 will be able to plan accordingly.

After a great morning at Project Fleur de Lis, we rushed to Ochsner Health System, which is southeast Louisiana’s largest non-profit, academic, multi-specialty, health care delivery system. We were fortunate to be able to meet with Dr. George Loss, and I think we’d all agree that it was one of the highlights of the trip.

In March 2015, six medical students in Geisel's Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city's challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

A Conversation with Dr. George Loss

By: Brendin Beaulieu-Jones '18

UHS-Nola-5After a great morning at Project Fleur de Lis, we rushed to Ochsner Health System, which is southeast Louisiana’s largest non-profit, academic, multi-specialty, health care delivery system. We were fortunate to be able to meet with Dr. George Loss, and I think we’d all agree that it was one of the highlights of the trip.

Dr. Loss, a graduate of Dartmouth College, is Chief of Ochsner’s Multi-Organ Transplant Institute and Chief of Surgical Services. Ochsner is the leading center for liver transplants, and it was intriguing to learn how Dr. Loss and his team acquire suitable donor organs to supply their patient’s growing needs. He described how facilities across the country pass up livers that they believe are too fatty for successful outcomes.  However, due to his team’s protocol and higher than expected outcomes, he is able to use livers that other facilities decline. In addition, Dr. Loss strives to retain the local supply of donor organs within Louisiana. He explained that by achieving the highest performance outcomes, competition is minimized as other liver transplant programs ask, “If Ochsner won’t use it, why should we?” It was remarkable to hear how Dr. Loss balanced Ochsner’s business objectives with advancing patient’s needs.

In addition, he described Ochsner’s commitment to improving the retrieval of organs and decreasing the gap between the actual donor rate and the utilized donor rate. We finished we a brief discussion of his team’s process for determining who ultimately received the scare supply of livers. It was fascinating to hear Dr. Loss share a few case studies and to consider the complicated ethical dilemmas that accompany each circumstance.

On Monday evening, we had the pleasure of having dinner with Dr. Elizabeth Sack, DMS ’10 at Domenica’s restaurant in downtown New Orleans. Dr. Sack recently finished her residency at Tulane University School of Medicine, where she served as chief resident in outpatient pediatrics.

In March 2015, six medical students in Geisel's Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city's challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Dinner with Dr. Elizabeth Sack

By: Brendin Beaulieu-Jones '18

On Monday evening, we had the pleasure of having dinner with Dr. Elizabeth Sack, DMS ’10 at Domenica’s restaurant in downtown New Orleans. Dr. Sack recently finished her residency at Tulane University School of Medicine, where she served as chief resident in outpatient pediatrics. We were very excited to hear that Dr. Sack and her husband have since welcomed their first child to their family.

UHS-Nola-4At dinner, we learned that Dr. Sack was selected as a Schweitzer Fellow during her time at Dartmouth. Her project focused on increasing awareness of end-of-life care among medical students and the community. Elizabeth took additional time off during medical school to travel to Lambaréné, Gabon as part of the Schweitzer program, where she served as a junior physician in pediatrics at a primary care clinic. It was wonderful to hear Dr. Sack describe how these experiences enriched her medical training and professional goals.

After spending the past few months with her newborn daughter, Dr. Sack will be joining a private practice outside of New Orleans. Interestingly, the practice serves a majority of patients who are either uninsured or insured through Medicare and/or Medicaid. It was very valuable to learn about Dr. Sack’s residency experience and her process of selecting her first job, as we are all eager to learn about the different possibilities of incorporating our interests in serving vulnerable populations in our future work.

We thank Dr. Sack for making the time to meet with the Urban Health Scholars, and wish her the best as she transitions into her new position.

Monday morning began with a visit to the Interim Louisiana State University Hospital (ILH) where we met with Susan Todd, Angela Davis-Collins, and Paolo Zambito. Susan Todd is executive director of 504HealthNet, an association of 22 non-profit and governmental organizations in the Greater New Orleans area that provides primary care and behavioral health services. Angela-Davis Collins is director of ambulatory care services at ILH and Paolo Zambito is senior vice president for strategy and business development at Louisiana Children's Medical Center (LCMC) Health.

In March 2015, six medical students in Geisel's Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city's challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Tour of ILH and University Medical Center

By: Dwan Pineros '18

Monday morning began with a visit to the Interim Louisiana State University Hospital (ILH) where we met with Susan Todd, Angela Davis-Collins, and Paolo Zambito. Susan Todd is executive director of 504HealthNet, an association of 22 non-profit and governmental organizations in the Greater New Orleans area that provides primary care and behavioral health services. Angela-Davis Collins is director of ambulatory care services at ILH and Paolo Zambito is senior vice president for strategy and business development at Louisiana Children's Medical Center (LCMC) Health.

UHS-Nola-3After introductions, Paolo Zambito gave us a brief history about the healthcare system in New Orleans and about the legacy of Charity Hospital and University Hospital in particular. Charity Hospital was founded in the 18th century and, along with Bellevue Hospital in New York, was among the oldest hospitals in the United States. Because of its location at the heart of the city, the hospital had been instrumental in providing care to the inner city populations of New Orleans. When Charity Hospital was closed in the aftermath of Hurricane Katrina, the city’s residents suffered a great loss and University Hospital became the area’s only Level 1 Trauma Center.

University Hospital was opened by the Daughters of Charity more than a century after Charity Hospital was founded. The hospital was purchased by the Louisiana State University System and together with Charity Hospital became part of the Louisiana State University Health Sciences Center, a public entity. Like its sister hospital, University Hospital sustained severe damage during Hurricane Katrina, but was not closed. The hospital was renovated and reopened after the storm. The hospital, now called ILH, continues to serve the people of New Orleans and is the main teaching hospital for the LSU Health Sciences Center.

Amid state budget cuts that affected the seven public hospitals in south Louisiana including ILH, the government of Louisiana announced in 2013 that LCMC Health, a non-profit corporation that managed the Children’s Hospital and Touro Infirmary, would lease and take over management and operations of ILH and the $1.2 billion University Medical Center slated to open this spring. Both facilities will be staffed by LSU faculty and residents and will continue to serve the uninsured. This public-private partnership exemplifies the trend of consolidation and privatization seen in healthcare nationwide.

After our meeting, we were given a tour of ILH by Angela Davis-Collins. Our tour included a visit to different departments including the Emergency Department and the Level 1 Trauma Center at the main hospital. The most memorable part of the tour, however, was a visit to the Medical Center of Louisiana at New Orleans Clinics and Ambulatory Services a few blocks down. The range of services offered at the site was wide, ranging from general surgery to physical therapy, among others. The most notable aspect of the medical center, however, was that it was housed in a former Lord and Taylor department store.

As we toured the Lord and Taylor building, it was uncanny how vestiges of an up-scale department store remained in spaces that were now put to use for very different purposes. The carpeted entrance where sales racks once stood was now a patient registration and waiting area. Examination rooms lined the tiled walkways and were separated from the walkways by temporary walls. Fitting rooms were now office space and white cabinetry for merchandise display stood empty. The improvised use of the Lord and Taylor department store gave the impression that the premises were meant to be temporary and indeed they were when patients were first seen. A little less than a decade after Hurricane Katrina, it was startling to see an interim arrangement become a permanent fixture in the provision of healthcare. This was about to change with the opening of the new $1.2 billion University Medical Center.

After our tour of the Medical Center of Louisiana, we met with Jay Buras, vice president of operations at ILH. He gave us a tour of the impressive new facility. The University Medical Center is almost complete and will open later this spring. All of the departments and clinics at the Lord and Taylor building will have a new home in this complex. The difference between the two sites is night and day.

For example, we toured the department for Physical Medicine and Rehabilitation at the Lord and Taylor Clinic. The space was drab and felt cramped with a single corridor in between different exercise stations.  The new home of the department was spacious and had a large window, which provided plenty of natural lighting. The atmosphere was much more welcoming and we could understand why the staff we had talked to earlier was eager and looking forward to the move.

As much as we delighted in the tour of University Medical Center, some of us wondered if some of the resources that went into this new facility could have been put to better use. For example, the facility can accommodate a much larger number of hospital beds and examination rooms, but this expanded capacity exceeds what is needed. Management will mitigate wasteful use of space by limiting the number of beds and work spaces each department can use. Another example is the installation of artwork in the main lobby that costs hundreds of thousands of dollars. In a state where budget cuts for healthcare and education are always imminent, it was hard to justify why a publicly funded hospital should install expensive artwork when so many other healthcare needs were unmet.

We felt privileged and very thankful to have been given a tour of ILH and the new University Medical Center by Angela Davis-Collins, Paolo Zambito, and Jay Buras. We hoped that the new facility will improve and advance medical care to the people of New Orleans in the spirit and mission of the old Charity Hospital.

After leaving an amazing meeting at Tulane Community Health Center, we made our way across town to one of the many Ochsner hospital sites here in New Orleans. Thanks to suggestions from a Dartmouth alum, we were put into contact with Dr. Robert Link, an Emergency Department physiciUHS-Nola-2an who happily agreed to let all 6 of us shadow in the emergency room.

In March 2015, six medical students in Geisel's Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city's challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Shadowing in Ochsner Clinic in the Emergency Department

By: Chinwe Echeazu '18

Saturday 3/15/15 - After leaving an amazing meeting at Tulane Community Health Center, we made our way across town to one of the many Ochsner hospital sites here in New Orleans. Thanks to suggestions from a Dartmouth alum, we were put into contact with Dr. Robert Link, an Emergency Department physiciUHS-Nola-2an who happily agreed to let all 6 of us shadow in the emergency room.

We were greeted with smiles and Southern hospitality as we entered the hospital, and we were given a brief history about Ochsner. It was the only Emergency Department that was still open after hurricane Katrina. Eleven health care facilities, including some in Louisiana, Alabama, Mississippi, and sometimes Texas, refer patients to Ochsner. The ER is usually so full that Ochsner was one of the first hospitals to implement a system called Que Tract. Within this system, patients are triaged at a much faster pace. The trauma levels I – III are seen first and once stabilized (and if possible) they are placed into sitting areas dispersed throughout the ER so that more patients may be removed from the waiting area. Dr. Link did state that this system has not been perfected and that although the pros are the ability to see more patients and remove them from the waiting room at a faster rate, the cons are unhappy patients that at times feel like they are not being attended to, and occasionally an overflow of beds. He stated that they are working on these issues.

We were split into pairs, Brendin and Freddy remained with Dr. Link, Andrea and Dwan shadowed with a second year resident in Emergency Medicine, Dr. Greenberg, and TJ and I shadowed a first year radiology resident. Just to name a few of the cases we saw, we were able to observe patients with: a fractured dens, an epidural hematoma, cholecystitis (this patient was discovered to have dozens of gall stones), mental disorders (ADHD, psychosis, bipolar disorder, depression, and anxiety) wounds that would not heal properly, abscess drainage, blunt force trauma to the face, and many more. Just that morning while meeting with Dr. Gugel at Tulane Community Health Center, we learned that Louisiana was almost the most violent state within the US and we were also informed that greater than 50% of patients seen have a mental disorder coupled with the ailment that brought them into the ER. So, unfortunately it was not surprising that we saw several patients diagnosed with a mental disorder or in the ER due to an injury from blunt force trauma. Not only were we able to see these various cases, we were constantly engaged throughout the observation and diagnosis process. We are humble and thankful to have been so welcomed and involved throughout the entire process. It was a wonderful experience, huge thanks to Dr. Link for arranging that for us.

In March 2015, six medical students in Geisel's Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city's challenging and distinct health care delivery system. In this first post, Chinwe Echeazu '18 writes about their arrival in New Orleans and visit to Tulane Community Health Center Clinic.

In March 2015, six medical students in Geisel's Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city's challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Tulane Community Health Center

By: Chinwe Echeazu '18 

We arrived into New Orleans on Friday 3/14/15. We immediately removed our jackets and enjoyed the warm breeze. After a long day of finals, driving, and flying, one would imagine that we would be exhausted and ready for bed. Although each and everyone of us was indeed exhausted, we were also quite excited to learn about the culture and health care systems within the beautiful city, New Orleans, Louisiana.

UHS-Nola-1bOur first meeting was with Dr. Gugel at Tulane Community Health Center Clinic. We could not have asked for a better introduction into the city. We were given, demographics and statistics specifically for the state as a whole and its major counties, and then a more focused overview regarding the clinic itself and the community that it serves.

Louisiana is raked 49 out of 50 of the most violent states within the US (50 being the worst and most violent). It is also one of the most impoverished states, having some of the lowest rates of life expectancy, over 33% of it’s children are overweight, and high occurrences of mental health illnesses are prevalent. The Tulane Community Health Center strives to address as many of these issues as possible by providing primary care, social services, and therapy to anyone who comes to their facility. They have also developed programs implemented in popular areas within the community aiming to increase levels of physical activity and promote healthier eating options. Although the center is composed of dedicated staff they are few in number and there is only one psychiatrist, limiting the amount of mental health services that can be provided. They are well aware of their challenges and actively search for ways to improve their services to the community they serve.

New Orleans has an extensive history and a rich culture, facts that Dr. Gugel did not hesitate to mention to us on various occasions (particularly while we were taking a tour of the clinic). The clinic has a “local music” theme and hanging on each examination room door is the name of either a current or historical jazz musician from New Orleans along with a portrait. It gives the clinic a fun feel while displaying the history of the city; it also depicts the extensive creativity that New Orleans has to offer.

We gained much insight into New Orleans and Louisiana and we departed from our meeting and tour with Dr. Gugel with what we believed to be a useful foundation to build upon as we began to visit more clinics and hospitals within the area.

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Fourth-year student Jaclyn Shameklis looks back at how far she and her classmates have come in medical school and how well they are prepared for the next steps in their medical careers.

By Jaclyn Shameklis  '15

During the past week, the fourth-year medical school class had the opportunity to sit and talk with the first- and second-year students.  We felt that it was important to reconnect with the underclassmen.  It felt so good to be back on the medical school campus!  What the meetings demonstrated to me most strikingly was a huge growth in confidence held by my fourth-year colleagues that had not been present at the start of this journey.

Medical school is a roller coaster of anxiety, stress, joy, hard work, fulfillment, and floundering.  You wonder if the first two years of classroom time will be applicable to any clinical medicine.  Then during clinical rotations, you wonder if you absorbed any of the knowledge you supposedly learned in lectures and hope you can extract it from memory at the particular time you get quizzed on it by an attending.  The amazing transformation that occurs without my classmates or myself realizing it is the growth in confidence in becoming physician-scientists.  There is no possible way to know it all, but you come to trust in yourself to figure it out.  I now know where to go for information on the run.  I know who to ask when I need help.  I know the personal limits of my medical knowledge.  And I have the peace of mind that I will be able to successfully interact with a patient and a patient’s family in a way that will demonstrate empathy, compassion, professionalism, and assurance in any clinical situation.

The fourth year is an exciting time in medical school, but it is also a terrifying time.  My classmates and I are looking forward to starting our internships, being productive and useful members of the healthcare team, and finally earning paychecks.  But we also worry about making errors, not knowing enough, not responding quickly enough, and of carrying the weight of responsibility of patient care.  It impressed me to see how far we’ve come as a class as I watched my friends reflect back on their medical school careers, gathering advice and tricks of the trade to pass on to those who are earlier in the process.

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As Rachel Brickman ('16) begins her fourth clinical rotation at Geisel, she finds that change is the one constant she can count on.

By Rachel Brickman (’16)

As I enter my fourth clinical rotation here at Geisel, I am beginning to notice a pattern of physical and mental occurrences that seem to come on at the dawn of each clerkship. My sleep is a bit restless as my mind struggles to suppress a new flurry of diagnoses and confusing hospital hallways. Katerina, my current roommate and fellow third year, can attest to the daily dishevelment of my blankets that bear the brunt of my nighttime thrashing. Even during the day, my shoulders feel tense and my forehead has a permanent furrow of puzzlement due to the overwhelming transition into what essentially feels like a new first day…except this is happening every six to eight weeks.

That’s both the beauty and the ugly truth of the clinical years of medical school – just as you find yourself in the groove of where to go, what to do, and which questions to ask (or never ask again), you are suddenly thrust into a new environment where you must start anew. So far, I have worked with adults and children; in private, public, and federal hospitals; 24-hour shifts and 7-hour shifts; loved some specialties and really disliked others. It’s essentially the opposite of that movie Groundhog Day – every day I wake up to find everything exactly the same different. The only consistent theme throughout these six months has been the love and support of my family and friends, and that is more than enough to keep my head clear and my shoes matching.

First-year medical student Andrew Park reflects on the strength of the Dartmouth community and how it came together after the passing of a classmate.

by Andrew Park '18

If you were to ask any member of the Geisel Class of 2018 why they chose to come here over the other medical schools to which they were accepted, the theme of having a closely knit and supportive community ranks on the top of the list. And during our first term at Geisel, Dartmouth has demonstrated how true this is.

I cannot think of another time when I felt more supported by the school than over this past Thanksgiving Break. The passing of fellow classmate, Kelsie Gleason, shook the entire school. Even those who had never met Kelsie, myself included, felt a great sense of loss. It truly felt as though there was a loss in our family. The way people responded to the tragic news reminded me how much we all care for one another, and reminded me of how valuable we all have become in each other’s lives.

The outpouring of support and love from fellow classmates and faculty members – from the Dean, the President of the College, and a good number of the medical school faculty – was touching, to say the least. It is unfortunate that such great loss had to pass to remind us of what we have at Geisel. The silver lining? Perhaps that we become that much closer as a community sooner rather than later.

This post is a formal-thank you to the Dartmouth community and to the Geisel School of Medicine. Medical school was never meant to be easy, and being from California, Hanover can sometimes (especially now) seem a suboptimal place to live. But I would not trade this Community that we have at Dartmouth for anything. There is something special here in the Upper Valley, and for that, we thank you.

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As third-year Geisel student Inyang Udo-Inyang begins an internal medicine rotation, he is reminded that being a physician is about more than just treating an illness.

by Inyang Udo-Inyang ('16)

Honestly, the start of internal medicine has been really tough for me. I've just completed my second week, but already the feelings of frustration are almost overwhelming.

Inyang Udo-Ingyang
Inyang Udo-Ingyang '16

My very first patient on internal medicine was an 86-year-old lady who presented to the emergency department with about a week of altered mental status. She was confused, unsure about where she was and what the date was. Every day, I would go and see her first thing in the morning to check on how she was doing and without fail I left her room feeling sorry. Even as she began to get better, I still couldn’t help the feeling. She just looked so alone in her hospital bed, with numerous strangers darting in and out of her room no one really spending that much time with her. Although we were treating her hyponatremia, it seemed to me that we were failing this lady. I knew it in my very core.

We met frequently and talked about her condition as a team. We discussed how to proceed with treating her hyponatremia and the various other chronic illnesses she had. As far as medicine goes, we were certainly giving her the right medications, drawing the right labs, consulting the right specialists. I became one of the few constant familiar faces in the course of her hospital stay and as she began to feel better she was able to voice her sadness and concern to me.

So little of our time was actually spent caring for this lady, being with her as she recovered, talking to her, the things I used to imagine doctors spent most of their time doing. The majority of our time was actually spent charting, putting in orders, checking labs, and other kinds of maneuvering with the electronic medical record.

One day, during the early stages of her recovery, I spoke to her in her native language of Spanish (she mentioned how much joy it brought her the first time I did this) and asked how she was feeling, she mentioned feeling alone and scared. Scared of her current situation, and scared of going back to the situation she was coming from, an assisted living environment in which she had felt neglected and forgotten.

Several days later, having fully recovered from her hyponatremia and preparing to leave, she said to me “Please don’t forget me, don’t let them forget me there.” I simply smiled, enveloped her hands in mine and assured her that I wouldn’t.

As a future physician, I yearn for that feeling of satisfaction at the end of the day. That feeling of satisfaction from having helped my patients solve the problems they brought to me. So far, that feeling has been a fleeting occurrence, certainly the exception rather than the rule. Medical discovery has grown in leaps and bounds within the last century. We now understand things about the human body that our forefathers could barely conceive of. However, in terms of caring for the sick people that come into the hospital, we do not seem to be making parallel progress. We have got to do a better job.